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Racial minorities are less likely to undergo major surgeries at the hospitals where those operations are done best, and black patients at Medicare HMOs fare worse than whites on several health measures regardless of plan quality, according to studies being released today.

The two studies in today's issue of the Journal of the American Medical Association, plus a third showing that black women are less likely than their white counterparts to survive breast cancer, add to the voluminous evidence that the U.S. health-care system works differently for minorities than for whites despite years of efforts to erase racial disparities. Studies have demonstrated that blacks and other minorities are far less likely than whites to receive many types of care, such as appendectomies, heart bypass surgery, or basic tests and drugs for heart disease and diabetes. Minorities on average are more prone to illness, have more complications and recover more slowly. They also are more likely to die from their illnesses, and to die younger. But while the persistent disparities are well-documented, the causes remain the focus of research and debate. One explanation is that minorities tend to be poorer and less educated, with less access to care. And they tend to live in places where doctors and hospitals provide lower quality care than elsewhere. Others suspect cultural or biological differences play a role, and there is a long-running debate about whether subtle racism infects the health-care system.